Advisory Group Member Application Form 2018 - Panel or Board Member

For longer answers, you can drag the bottom right-hand corner of a text-entry field to expand the size. If you have any other queries about how to fill out this form, please do not hesitate to contact us on 023 8059 5586 or at netsagmembership@nihr.ac.uk

Section 1

Role/s for which you wish to be considered

Role A:

Role reference number (required)

Role title (required)

Role B (optional)

Role reference number

Role title

Section 2

Contact Details

Title (required)

First name (required)

Middle name(s)

Surname (required)

Suffix

Primary (work) details

Job title (required)

Primary specialty (required)

Department / school

Organisation (required)

Type of affiliation

Address (required)

Town / City (required)

County

Postcode (required)

Email Address (required)

Telephone

Web address (please include the full link, eg https://www.google.co.uk)

Other affiliated organisations and contact details

Other organisations and details

Section 3

Professional Details

3a. Summary

Please summarise your knowledge, skills and experience using up to five key words or phrases (such as service management, health economics, questionnaire design, paediatrics, obesity etc.) in the spaces below. The words you provide should summarise your content knowledge as well as any relevant research methods expertise.

1 (required)

2 (required)

3 (required)

4

5

3b. Research methodology skills

If applicable, please list the research methodology skills in which you have reached a strong level of competency. (Maximum 2000 characters).

Research methodology skills

3c. Knowledge, skills and experience

Please detail your specialist knowledge, skills and experience and how they demonstrate your suitability for an advisory group role, referring to the criteria in the person specification (see guidance notes). (Maximum 5000 characters)

Knowledge, skills and experience (required)

3d. Additional question for applicants to any HTA Board

Experience of reviewing for the HTA programme is a requirement when applying for membership of any HTA Board. Please detail your HTA reviewing experience if applicable. (Maximum 5000 characters)

HTA experience

Section 4

Panel or board membership

4a. Current or previous memberships

Please provide details of any current or expired panel or board membership for the NIHR or other research funders within the last 3 years. (Maximum 5000 characters)

Previous or current memberships

4b. Other applications

Have you recently applied for any other panel or board member positions with other funders which may affect your ability to take a role if offered?

Other applications

Yes

No

If yes, please give details where possible (Maximum 2000 characters)

Other application details

Section 5

Getting involved in reviewing

From time to time we invite people with relevant knowledge and expertise to undertake reviews for NIHR programmes on the content of short briefing papers, proposals for research, and final reports of research findings.

If you do not wish to be contacted about reviewing please tick here:

Don't contact me about reviewing

We publish an annual list of reviewers who have completed a review for us during the past year. If you are asked to review, your contribution as a reviewer will be acknowledged on our website as a gesture of our appreciation. We will only list your name, and ensure that there is no indication of the reviewing task that you completed. If you would prefer us not to publish your details, please indicate this by ticking here:

Don't publish my reviewing details

*Please note applicants in receipt of NIHR funding are obliged to review for NIHR

Section 6

Please tell us how you heard about our panel and board member opportunities

I heard about the NIHR vacancies through...

Applied previously

Word of mouth

Internet search

Advert

Twitter

LinkedIn

NIHR Bulletin / Email

Facebook

Other (please specify below)

If other please specify

Section 7

Supporting documents

Your personal information is held and used in compliance with the General Data Protection Regulation 2016 (GDPR). The Department of Health and Social Care, National Institute for Health Research (DHSC NIHR) is the Data Controller under GDPR. Under GDPR, we have a legal duty to protect any information we collect from you. You should be aware that information given to us might be shared with other DHSC NIHR bodies for the purposes of statistical analysis and other DHSC NIHR management purposes. We also reserve the right to share details of research applications with other approved research funding organisations outside the NIHR in order to coordinate research activity in the UK. Information collected from you will not be passed to any third party outside the NIHR except specifically as detailed above without your consent except where we are under a statutory obligation or entitled to do so by law. Applicants may be assured that DHSC NIHR is committed to protecting privacy and to processing all personal information in a manner that meets the requirements of GDPR. You can ask for your details to be removed from our database at any time.

Supporting documents

I have attached my CV (required)

I have read and understood the data protection statement (required)

Please note

If your application fails to submit, please note that you will have to re-attach your files and re-select checkboxes.